New Zealand Cardiology Wards and Adventures Taylor Myers

New Zealand Cardiology Wards and Adventures Taylor Myers Locke

• • • New Zealand Healthcare System Cardiovascular care in New Zealand Identifying cardiovascular at-risk populations Improvements in the Cardiovascular Healthcare delivery Comparison to Kansan’s health Kansas Heart and Stroke Collaborative: understanding, identifying, and comparison • New Zealand adventures Objectives

• Funded by public, private and nongovernmental sectors • Tax resources provided 83 percent of healthcare • Improvement needed • • Rural Asian, Pacific Islander, Maori adult population Systematic care New Zealand Healthcare Model www. moh. govt. nz

• Non-profit boards made of a combination of elected, appointed and Maori representatives • responsibility of healthcare planning, funding and implementation is broken up geographically • High degree of autonomy • Not all created equal District Health Boards http: //www. whyora. co. nz/Understanding-health/Health-Systems/

Auckland City Hospital

• Heart disease accounts for 30 percent of national mortality • Increasing admission rates for ACS and AMI • Multidisciplinary approach to heart failure treatment State of New Zealand Cardiovascular Disease Elliott J and Richards M.

• Comprise 15% of New Zealand’s population • CV disease (CVD) is highest • Coronary Artery Disease Death occurs on average a decade earlier • < 65 in 45 % of Maori population vs 11% in non-Maori • Increased CVD risk factors • Smoking, hypertension, diabetes mellitus Maori Population Whalley GA, et al. http: //www. businessinsider. com. au/jimmy-nelsons-tribal-photos-before-they-pass-away-2014 -2

• Started in 2002, aimed to improve ACS outcomes • Identified weaknesses with rural and Maori populations, 50% less investigations and revascularization procedures in certain DHBs • The 2012 audit recognized gaps in access to echocardiography, cardiac angiography, and delays in care at non-intervention centers ACS NZ Audits and Improvements NZACS SNAPSHOT Audit Group

• Large rural population resulting in lack of access • Coronary heart disease mortality rates have decreased at national and state level • Highest mortality rates in rural Kansas • CAD risk factor rates have increased • Diabetes mellitus, obesity, hypertension Comparison to Kansans? Kansas Department of Health and Environment

• Transforming model of care for heart and stroke disease, in areas traditionally with limited access • Preventative and post event care managed by care managers and health coaches within the community • Developing shared clinical guidelines, and EMRs Kansas Heart and Stroke Collaborative Ranney, Dave.

• Combining preventative to quaternary care (like the DHBs in New Zealand) • Shared Clinical Guidelines • Community healthcare providers to help manage patient with diagnosis and discharge • Heart failure nurse managers in New Zealand • No national EMR and poor information exchange Key Contrasts

• Young Pacific Islander immigrants or Maori population hospitalized for CV disease • Reasonable expectations for disease state and end-of-life • Conscious of ordering unnecessary tests and procedures • Long wait time for specialist care and work up • Heavily dependent on general practitioner Kiwi Healthcare Culture http: //www. kiwibird. org/

• Mr. S had right sided heart failure with subsequent end stage liver disease requiring Lasix drip, followed by pressor support • Family highly involved in care • Stayed on cardiology ward throughout stay, never in CCU or MICU • My work up and management differed • Maybe less is more? Clinical Experience

• New Zealand health infrastructure is evolving, but well managed and providing quality care throughout the nation • New Zealander’s struggle with cardiovascular risk factors and disease, especially the Maori population • Community support and standardization throughout New Zealand is a model that is loosely reflected in the Kansas Heart and Stroke Collaborative • Clinicians should be open to change and challenged to provide the best care possible Conclusions

Sometimes, you have to jump

… and enjoy the view

• New Zealand Health System Review. Health Systems in Transition, World Health Organization, Vol. 4 No. 2. 2014. • Whalley GA, et al. Higher prevalence of left ventricular hypertrophy in two Māori cohorts: findings from the Hauora Manawa/Community Heart Study. Australian and New Zealand journal of public health. 2015 -01 -05; n-a-n/a. • Elliott J, Richards M. Heart attacks and unstable angina (acute coronary syndromes) have doubled in New Zealand since 1989: how do we best manage the epidemic? N Z Med J. 2005; 118 (1223). • New Zealand Acute Coronary Syndromes (NZACS) SNAPSHOT Audit Group. The management of acute coronary syndrome patients across New Zealand in 2012: results of a third comprehensive nationwide audit and observations of current interventional care. N Z Med J. 2013 Dec 13; 126(1387): 36 -68. • Ranney, Dave. "Moser to Lead Heart Disease, Stroke Collaborative at KU Hospital - See More At: Http: //www. khi. org/news/article/moser-lead-heart-disease-stroke-collaborative/#sthash. Zik 3 k 6 b. G. v 6 Et. Js 8 Y. dpuf. " Kansas Health Institute. 5 Dec. 2014. Web. 24 Mar. 2015. • "Working Together for a Healthy Kansas: Kansas Action Plan for Heart Disease and Stroke Prevention, 2012 -2017. " Kansas Department of Health and Environment. Heart and Stroke Alliance of Kansas, 1 Apr. 2013. Web. 24 Mar. 2015. . References